Hepatitis C Patients: How To Get Around The Cost of Solvadi

In the United States, getting 12 weeks of treatment with Solvadi is billed at $84,000. Naturally, health insurance companies would prefer that their patients get a cheaper, less effective drug. Many of the people who need the drug most have been sick for years, have become impoverished, and rely on government assistance for their healthcare. State Medicaid budgets, aiding the poor, have been so strained by the cost of the drug that some states, such as Texas, won't pay for the drug at all. 

Gilead Sciences, Inc., the company that makes Solvadi, has licensed 11 companies in India to make a generic version of the drug at affordable prices (about $1,000 per patient) in 91 countries in the developing world. However, it is not yet offering a discount for hepatitis C patients in middle-income countries such as Russia, China, Brazil, Serbia, or Ukraine. Treating the 40 million people who have hepatitis C in those countries would cost (and earn the company) over $3 trillion at the rates it charges in the United States. Worldwide, the drug would earn the company, in theory, over $20 trillion, or about 1/5 of the total wealth of the United States, just for one medication.

Naturally, organizations like the  Initiative for Medicines, Access and Knowledge, based in New York City, are filing legal challenges to make the medication more widely available in the countries where it is needed most. Court challenges, however, take years, and in the meantime, patients need treatment. Here are some ways to try to get the medication if you and your doctor believe you would benefit from it. Since the most difficult place in the world to get the drug is the United States, where the company charges the most, here is what you need to know.

• Some insurance plans (such as Health Net, Blue Cross/Blue Shield, Anthem/Express Scripts, Aetna, CVS/Caremark, and Humana) cover the drug but only with prior authorization.
• To get prior authorization, your doctor will need to certify that (1) you have agreed in writing to cooperate with your treatment and stick with the drug until it has a chance to work, (2) you don't have a condition (such as kidney disease) that would be made worse by Sovaldi, (3) you have a diagnosis of chronic, compensated liver disease and (4) a liver biopsy has found that you have scar tissue in your liver. (Also, women who could become pregnant must agree to use contraception, in order to prevent birth defects.) The fourth requirement is a problem for about 70 percent of people who have hepatitis C, because they are sick enough to need treatment but don't yet have changes in the liver itself.
• Most plans will also require documentation that you have not used illegal drugs for at least six months before they authorize the treatment.

It's entirely possible that a Silver Plan with premium assistance (referring to the Obamacare categories) could result in your having to pay nothing at all if you have already met your copays and maximum out of pocket for the year.

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